House, M.D. s05e08 Episode Script

We're starting a fund.
Then you don't need me.
The man's injured, can't work.
His fault.
We're family, we depend on each other.
We're not family, we're co-workers.
He's not even that any more.
I can't believe you just said that.
Can't come between a man and his beer money.
See the big heavy machinery? I'm sorry, but he should give.
You gave.
Go back to work.
Paolo is the one who got you off the night shift.
It's not like I asked him.
Also covered for you Labor Day weekend.
But, hey, it's America, if you don't want to contribute If you don't want to Oh, gosh.
Get an ambulance.
Morning.
Don't want to hear it.
So, I take it you did not ask Cuddy out.
Yeah.
"Yeah" I didn't or "Yeah" I did? Whichever one means you almost had me convinced it was a good idea.
Oh.
Nothing to say? No.
"No" you don't or "No" you don't don't.
Whichever one means no.
Is this some kind of a reverse No.
House? Sixteen-year-old girl with fluid in her lungs.
No previous trauma, lung or cardiac issues.
Gram stain was negative, no bacteria, no pneumonia.
She's a factory worker, means she probably works close to a lot of recent immigrants.
Thank God some of those offshore sweatshop jobs are coming back to America.
She's an emancipated minor.
In a factory? Either an Olympic gymnast who busted her leg a child star who blew all her sequel money on drugs or she's just a lying runaway.
Her parents died last year.
No relatives.
To avoid foster care, she got a GED and got emancipated.
Could have picked up a parasite from a co-worker.
She'd be having GI problems.
Pregnancy's more likely.
Sparks a fluid overload, hits the lungs, causes the pulmonary edema.
Her history says she's not sexually active.
And our history says she could be lying.
But not every teenager is having sex.
But every teenager is stupid.
Teenagers on their own are stupider.
The girl's holding down a job, makes her rent.
On the one hand, Kutner's right maybe she's a sweet young thing who's not a screw-up lying through her teeth.
On the two hand, pregnancy test only takes five minutes and we no longer kill rabbits so, in conclusion, shut up, do the test.
What else? Drugs could damage the heart.
Pressure imbalance allows fluid to build up in the lungs.
Tox screen's clean.
For drugs used recently, not for drugs used before recently.
Sixteen doesn't automatically mean a risky lifestyle.
Didn't we just have this conversation? Kutner trusts her, someone else doesn't.
So, in conclusion, shut up check her home and work for toxins or drugs.
Kutner and Foreman, do an echo find the extent of the heart damage.
Kutner can do the echo on his own.
Yes, but he'll be very lonely so I have to ask why.
I've been asked to help run a clinical trial.
That okay with you? Good for your career, great for your street cred.
What's in it for me? You have four doctors and never more than one case.
Means I have time to work on other things and they all have more chances to step up, stand on their own.
And if there is an emergency with Annie should she wait until you finish grooming lab rats? If there's a problem with Sophia or any other patient, you know I'll be there.
Your patient is my priority.
No.
What? You want a reason? Clinical trials take time, your time is my time.
I told you, I don't do drugs.
Still a good idea to check your heart.
Something else could've damaged it.
You find it hard, being all on your own? Having to do everything without Drugs to ease my pain? That's not A teenager on her own I wouldn't trust me either.
I meant it must be hard.
No one there to back you up.
I know you're trying to be nice, but I'm not into the whole pity thing.
I was actually doing the "I get it" thing.
I lost my parents when I was six.
It doesn't go away, but it gets easier.
You learn to deal.
I still get nervous when there's a knock on the door.
Always think it's the state trooper with more bad news.
You already got the worst news and survived.
That's sort of the upside.
Your heart's healthy.
Isn't that good news? For your heart, yeah, but it also means we still don't know what's wrong.
Check book balanced, place spotless looks like she builds her own furniture.
If you're this grown-up at 16, what happens at 30? You turn back into a kid, like Kutner.
Kutner's not that bad.
He needs everything to be nice, wants to see the best in everyone.
Kitchen's clear.
Yeah, friendly is a dangerous thing.
There is such a thing as too trusting.
Corollary is there's such a thing as not trusting enough.
Too much, you get hurt.
Not enough, you don't live.
So, the object in life is to get hurt just the right amount? Excuse me if I don't go out of my way to take relationship advice from you.
And trust should be earned.
Bong means nothing, drugs are irrelevant.
Relevant if she's taking them.
Even if she is, irrelevant.
Echo showed no heart damage.
Would that be the echo that Foreman chose not to run with you after I dashed his new drug discovery dreams? You mad at me because you think Kutner screwed up the echo? I didn't screw up the echo.
I know.
No structural heart damage.
So, if it's not the heart It's the heart.
Didn't you just say it's not? Not all heart damage has to be structural.
Drugs could have caused intermittent tachycardia.
Irregular heartbeat would account for the pulmonary edema.
Edema was acute, vasculitis makes more sense.
There's no sign in her blood work and if she had vasculitis, she'd be too weak to work in the factory.
She builds her own furniture, you think she skips work 'cause she's feeling a little weak? She needs steroids.
Steroids could cause an irregular heartbeat making her current one irregular-er.
Foreman, start her on beta-blockers.
Rest of you, do anything that isn't starting her on beta-blockers.
Start her on the treatment.
Page me if you need me.
Irregular heartbeat causes blood to back up behind the heart and into the lungs.
The beta-blockers keep this from happening.
I thought the test showed my heart was fine.
It's tricky.
An arrhythmia can come and go.
So, you don't believe me or the test.
You guys are more cynical than I am.
We found the bong in your apartment.
You went into my apartment? Extended drug use can damage The bong belongs to my ex.
It's why he's ex.
That doesn't mean you didn't use it.
No.
You have no reason to trust me.
You have to do your treatment.
The other possibility is you have vasculitis.
The treatment for that is steroids.
If you've been using drugs, if they've damaged your heart and I start you on steroids, they could kill you.
I haven't used drugs.
I'll get the steroids.
Why are you here? I owe clinic hours.
No, you don't.
I'm here because House doesn't want me to be here.
I'm guessing he said no to the clinical trials.
He didn't need to say no, he just wanted to say no.
House did something solely out of self-interest? Freaky.
Don't suppose you want to override No.
What do you think this is going to prove? Does it matter? Just figured you could use some help down here.
And you spending two hours wiping noses will annoy House.
If that is your dream, God bless.
If you want to prove you can do his job and something more His puke is red.
That's blood, right? That hurt? How about that? Four days he's been like this.
It's just getting worse.
Maybe he just needs to poop.
Evan.
What? Worked last time I had a stomach ache.
That's actually a smart idea which is why that's the first thing the other doctors checked.
His insides are clear.
Anyone else sick at day-care? No.
How about his friends? No.
No one.
What's happening to him? Not sure yet.
Don't worry, I've got an idea.
You can make him better, right? That's my plan.
You need to make him better.
Stay the hell away from me.
Just calm down.
What happened? I adjusted her IV, and she went crazy.
Don't touch me! Leave me alone! Sophia, it's okay, we're here to help you.
Just stay away from me! Don't touch me! I said don't Get your hands off of me.
Get your hands Beta-blockers don't cause psychotic breaks.
She's not on beta-blockers.
We started her on haloperidol, she's stable.
Lab tests show the delirium wasn't caused by a metabolic problem.
Means we still don't know what caused it.
Yeah, we do.
Nice job, Foreman.
I didn't switch her meds.
But your decision to stick it to the man clearly inspired Oliver Twist.
I treated her based on the symptoms she presented.
You treated her based on empathetic orphan syndrome and almost killed her in the process.
She wasn't on steroids long enough for it to cause the delirium.
It's a new symptom.
One that rules out vasculitis.
And arrhythmia.
The psychotic break caused a surge of adrenaline but no irregular heartbeat.
Heart's not the problem.
We're both wrong.
So, what causes lung issues and delirium and is not based on wishful thinking that she's safe and happy? Prinzmetal angina.
Silent and unhappy is better than vocal and unhelpful.
If you'd run the echo that you didn't run before giving her the beta-blockers that you didn't give her if you'd listened to what Kutner said you'd know it's not a heart problem.
I'm not talking about her heart, I'm talking about her head.
Prinzmetal angina doesn't affect No reason it couldn't cause an artery in the brain to spasm.
Leads to the delirium and the pulmonary edema.
Foreman, give her Ergonovine to cause vasospasms and run an fMRI to see which artery's dancing.
And when I say Foreman, I mean Foreman.
I want his signature on the paperwork.
I want videotape.
I want photographs of him with the patient and today's newspaper.
Set her up.
When you're ready House wants you To do the procedure.
When you get everything set up, page me.
That's really a camera? Pretty cool, huh? This can go places the other scopes can't.
Jonah, I need you to swallow this pill.
Don't wanna.
It doesn't hurt, promise.
Jonah, please, this will help make you better.
I don't want to be mean, but if you don't do this, we'll have to make you.
It's a power pill.
It's not just a camera, it makes your muscles grow.
Like the vitamins we take, except this was made with a secret formula.
You did great, sweetheart.
You're very brave.
Jonah's lucky.
I was pretty cruel to my little brother when I was your age.
Why? I guess I thought it's what big brothers did.
Obviously, I was wrong.
Is he a doctor, too? No.
Does the pill tickle, sweetie? He can't feel it.
What's funny? Your brother? What's happening? I don't know.
How are you guys getting along? And you suddenly care why? House was asking questions last week.
I assume Foreman needs us and he's worried that if we're sniping, we might be distracted.
That's kind of insulting, isn't it? Very.
You're obviously fine.
I need a differential for uncontrollable giggling.
He's four, they laugh.
Yeah, nothing like diarrhea and bloody vomit to put you in the mood to goof around.
I've looked down one end and up the other.
All the tests came back clean.
Can't figure this out.
You can't? Don't you work with three other doctors and a grouchy gimp? This isn't House's case.
Just so you know, whatever you're trying to prove, it won't be enough.
Gotta go.
Sorry.
You didn't miss much.
No spasms yet.
Nothing in the anterior or posterior cerebral arteries.
How much longer? Just a few more minutes.
Were your foster homes all around here, or did you have to change schools? Is chatting about lousy foster parents supposed to relax me? Left middle cerebral artery looks good.
My foster parents were great.
I think most foster parents do it because they want to do something decent.
Which is why you didn't get emancipated.
Nothing around the vertebral artery.
No sign of spasms.
But that's odd.
How'd you find out about your parents? Told you.
State trooper.
Look at that.
Arteries are fine.
You can stop.
Not that.
I forget.
Did he come to your house, or call you down to the station? Came to my house.
I cried into the guy's shirt for an hour.
Wow.
FMRIs tell us where the blood flow is.
You were using your limbic region.
Lights up when we use our imagination, doesn't light up when we're telling the truth.
Your parents aren't dead, are they? I risked my job, put you on a different treatment.
I didn't lie about the drugs.
Then why lie about your parents? Because I wish they were dead.
I got emancipated because my dad raped me and my mom pretended it didn't happen.
No signs of spasm, impeded blood flow or brain dysfunction.
It's not Prinzmetal's.
All the fMRI showed is House was right.
She was lying.
Only relevant if it could cause pulmonary edema and delirium.
We find out our patient's been raped, and that's your response? Is she a psych patient? Rape could mean STD.
Thank goodness, one of you doesn't have a heart.
Maybe if we all stop wringing our hands, we could solve this thing and let her live to have a few more nightmares.
Gonococcal endocarditis would explain the pulmonary edema, the delirium.
No sign in her blood work.
Could be lying about the rape.
Yesterday, you were all BFF, now you think she's pathological.
Yesterday, I had no reason to doubt her.
If she'd been honest with us from the beginning She lied about dead parents because it's better than rapist parents.
You find that unsympathetic? That's it.
What's it? Her whole life's a mess.
What rhymes with mess? It's not stress.
She has none of the usual manifestations.
No hormone imbalance, no cardiac Yeah, she's drowning in her own lungs, and she's delirious.
She's a picture of emotional health.
Severe emotional stress can lead to asymmetric function of the mid-brain.
Explains the delirium.
Interruption in the brain-heart coupling could cause pulmonary edema.
Even if House is wrong, the treatment's basically anti-anxiety meds.
Hard to argue with.
Yes, I agree, it does explain everything.
Thirteen, load her up on diazepam.
Foreman, make sure she does it.
Thirteen, make sure he makes sure.
I went to Cuddy's house.
But I didn't go in.
Went home without ringing either her metaphorical or actual bell.
Huh.
You're processing.
I'm scrubbing.
"Huh" means processing.
"Huh" means acknowledging.
If you prefer, I could say "hah" or "hmm" or No insights? No opinions? You're disappointed.
You made a decision.
I can't tell you what's right for you.
Seriously? Because last week you could.
Last year, you could.
Seems to come pretty easy to you.
Do you want me to tell you what you should do? I want you to stop thinking that acting inscrutable makes you anything other than annoying.
Interesting.
Holding things in can give you cancer.
Kid's in day-care, could be meningitis.
No fever, no stiffness, no rash.
You check his thyroid? TSH, T3, T4 were within range.
Ruled out all the usual suspects.
Nothing's usual for a 4-year-old.
And as fun as this is, it feels like we're your goomah.
Your feelings are hurt? Either you can handle both these cases or you can't.
If you can't, it's dangerous and stupid.
On the other hand, stomach cancer, leiomyosarcoma.
Long shot.
Altered mental status means porphyria's more likely.
No abdominal pain.
Cancer explains the lethargy, the GI symptoms.
Neither is perfect.
Then we test for both.
And by "we" you mean the collective, not you? Thanks.
Severe stress scrambles the way the brain communicates with the rest of the body.
I have a problem with my brain? Not exactly.
The problem would be with your body chemistry.
Where's Dr.
Kutner? There's four of us, it's my turn.
I'm sorry I lied about my parents.
You did what you thought you had to do to protect yourself.
If we're right, we should see a change in your lungs pretty fast.
Then we can figure out how to manage your stress.
It might help to turn him in, file a police report.
Get closure.
Won't help.
Not addressing what happened won't make it go away.
Yeah? What do I have to do to make it go away? I didn't mean that.
I just mean that you I addressed it.
I got away from him.
Reporting it just labels me "girl raped by dad.
" It doesn't have to define you.
It's how you see me.
It's why you're treating me with tranquillizers.
Not any more.
Stress wouldn't change your urine color.
Labs show the brown urine was caused by shredded red cells.
So, what messes with her lungs, her mental status and runs her blood through a wood chipper? Factory lunch rooms aren't the cleanest places.
Could have picked up E.
Coli.
Or Shigella, from the restroom.
Either would account for the red cells, the delirium.
But not the original lung symptoms.
Legionnaire's could and cause delirium.
No, her sodium's normal.
What did her furniture look like? You said it was homemade.
Old boxes, what? It was wood, nailed together.
The wood have little dents or holes? I didn't see any on the bookshelves, but they were painted.
The desk did.
Looked like she'd stapled stuff all over it.
Holes means that it was pressure treated.
Sawing or burning it releases arsenic into the air and into her lungs.
Tests didn't show 'Cause it found a cloak of invisibility hiding Arsenic gets absorbed in the internal organs so it doesn't show up on the blood test.
Test her hair.
If it's positive, chelate it out of her blood.
No cancer, no porphyria.
You paged me with negative test results? Yes, because it means we're done.
Since we still don't know what's wrong this kid has a real problem.
Talk to House? Not his case.
There's a point when Cameron and I aren't enough.
We're not there.
We need to run some more tests.
A week ago, he was a happy little boy, playing with his brother and now he can barely lift his head.
We'll figure this out.
I just need Mom.
Help.
We need a crash cart.
What's going on? He's in cardiac arrest.
Get them out of here.
Clear.
Nothing.
Go again.
Clear.
He's back.
Foreman, we're there.
Chelation's complete.
You're arsenic-free.
So, I can get out of here? In the morning.
That's it? No advice? No, "Be careful out there, kiddo"? You want my advice? Want is one thing, expect is another.
I wish I could tell you what to do.
But you're strong.
You've made good choices.
You'll be fine.
Thanks.
Need four milligrams of Lorazepam.
After the seizure, we ran a new MRI.
This is Sophia's brain three days ago, this is her brain today.
Lesions.
Magical lesions, which appear out of nowhere.
She was cured, then she wasn't.
Lesions grew too fast for cancer.
Could be infection, MRSA.
WBC count would be through the roof.
Put the arsenic back.
You wanna treat a patient nearly poisoned to death by giving her more poison? Just because we call something a poison doesn't mean it's bad for you.
It was killing her.
But since she's still dying, the arsenic, obviously, wasn't killing her.
And since she's now getting worse, the arsenic was obviously fighting the killer.
It's a hero.
We should be organizing a parade.
So, what does arsenic treat? Syphilis.
Before penicillin, the treatment was arsenic.
We already ruled out STDs, and even if we were wrong that much arsenic in her system would have wiped out the syphilis.
Acute promyelocytic leukemia is still treated with arsenic.
APL explains the lesions and why they appeared after we took the arsenic out.
So, put the arsenic back.
We still have a problem.
Arsenic slows leukemia, but it can't cure it.
If she wants to see 17, she's gonna need a bone marrow transplant.
The best match would be a sibling or a parent.
Biopsy a lesion, confirm that she's dying, and load her up with arsenic.
Keep her alive till you can convince her that rapist marrow and rapist-enabling marrow work just as well as the unleaded stuff.
We need to talk.
This about the case you didn't want me to know about? Cuddy? Foreman.
You didn't flinch when you found out about a 16-year-old who could be dying in the next few days.
Means you're here about someone even younger, dying even faster.
He needs you.
But he has you.
This boy is going to die.
You selfish enough to let it happen? Pot calling a kettle a pot? You're a hypocrite.
If our job is to find out what's killing patients, you'd help this kid.
But you'd rather play mind games to prove you're the only one with magical powers.
You wanted something all your own, now you got it.
Your disengagement won't work.
I can see that.
You think that when you tell me what I should do my instincts are to push back so that by not telling me what you think I should do I'll do what you think I should do.
I sound convoluted.
Disengagement is neither artful, nor effective.
So, my not doing anything isn't causing you to do anything.
Right.
I'm okay with that.
No, you're not.
You are designed to have opinions and to force them on people.
I'm starting to sound desperate.
Don't screw with my stuff.
I just need a donor with the same blood type or something, right? Actually, bone marrow's a little more complex.
The best donors are immediate family.
But those donor banks have thousands of names.
Your parents' similar DNA gives you a much better chance No.
If I do this I'll owe my life to them.
It would mean everything else that happened was somehow okay.
They don't deserve that.
They're not in my life.
If that means I'm dead, then I'm dead.
I have Huntington's disease.
I'm dying.
I don't know when it will happen, but it'll be sooner than I ever planned and I'd do anything to stop it.
Because the only way to make anything right the only way to make your life matter is to live as long and as well as you possibly can.
Have you ever been raped? No.
Don't try to walk in my shoes, and I won't try to walk in yours.
You had no right.
To try to convince her to do the right thing? To lie to her.
It's a true story.
Who cares if it's not my story? It's my life.
It's her life.
The point wasn't I'm dying, the point was she should live.
You should have told her.
Instead you tell her to call the cops, give her stats on DNA markers.
Everything's by the book, nothing is ever personal.
Trying to sleep here.
Biopsy confirmed APL.
She needs a bone marrow transplant.
Run the donor banks.
I'm going home.
We need to track down her parents.
I assume she's already said no to that idea or there'd be no need to screw up your courage before saying it.
Children who've been through trauma can't think clearly.
Children who've been through trauma and are dying Guess I'm the only one who cares about patient rights.
What she wants could kill her, what she needs could save her.
Our job is to find out what's killing patients, not treat them for chronic idiocy.
Idiocy is what's killing her.
And since we can't cure that, I'm going home.
We could save this patient, but all you care about is getting your answer.
Your point being? Taub and Kutner can check the donor banks.
I'm gonna find her parents.
Can't see why you're surprised.
You push against House, he's going to push back.
Against me, I get, but his ego's killing my patient.
You liked this case because he wasn't looming over you the decisions were yours.
Only difference now is he decided not to loom.
Doesn't change the fact that your patient's dying.
What are we missing? What's not in the file? The mother.
Overburdened, at the end of her rope.
Makes her kid sick, so someone else will take care of him sympathize with her.
Munchausen by proxy? She brought him to the clinic, was with him when he went into cardiac arrest.
The brother would have noticed, said something.
Evan's even more protective than she is.
Then maybe it's the brother.
He's eight.
Could be jealous.
He's the opposite of jealous.
He includes Jonah in everything he does.
Makes sure he eats, brushes his teeth You think we gave him an idea? Either that or he's off to kill House.
Mr.
Valez? Yeah? I'm Dr.
Remy Hadley from Princeton-Plainsboro Hospital.
We're treating your daughter, Sophia, for leukemia and we need to test both you and your wife for bone marrow donation.
I'm sorry, you said you're from Princeton-Plainsboro? I know this is unexpected, but time is short and What's going on? This doctor says you have leukemia.
I don't have leukemia.
Sophia Valez? Yeah? Sophia Isabel Valez? Yeah.
Do you know something I don't? Just that liars lie.
You stole her identity.
To protect myself.
So they can't find me.
We can protect you, but we need to find your parents.
Why? You have my blood, you don't need my name to find a donor.
You're a minor, you, obviously, forged the emancipation papers.
Even if we had a donor, we'd still need your parents' consent to treat you.
Can't you just pretend you didn't go to that house that you didn't find that girl? Calling your parents doesn't mean a family reunion.
You don't even have to see them.
When I get sick enough, it'll be an emergency.
You'll have to give me a transplant, even without consent.
An iron overdose? From his vitamins.
If I'm right, we can treat him tonight.
He'll be back to his old self in the morning.
But they're children's vitamins, I only give him one.
I know.
I thought more would make him strong.
I didn't mean to make him sick.
He's gonna be okay.
He's gonna hate me.
That's the great thing about brothers.
You can make mistakes, and they'll still love you.
Donor list turned up a partial match.
So treat her.
It's only a three out of six.
So don't treat her.
She may not last the week.
Partial's better than nothing.
So treat her.
She'll reject it then she'll be too weak to try again when a better match turns up.
It's my turn now, right? If a better match turns up.
Well, when you decide, get back to me.
She's scared.
Not scared enough.
Tell her the thing about emotional reactions is they're definitionally irrational or stupid.
You might want to phrase that in your own words.
She wants to deny her parents the satisfaction of saving her life.
That's your rational explanation of her emotional response.
That was her explanation.
That makes sense.
How long did it take her to come up with that? It was her immediate reaction.
That doesn't make sense.
The fact that it makes sense doesn't make sense? Emotional is immediate.
She went to rational first, means there was no emotional to process.
You're saying she's lying about being raped? Wouldn't be her first.
She lied about one trauma to cover a worse trauma.
So, what's worse than rape? Hi.
I'm Dr.
House.
What did you do? I don't Something happened, but it wasn't rape.
Believe whatever you want.
You're scared and stubborn and you don't like people feeling sorry for you.
Why not? I don't want pity, I just want to be normal.
But you know you're not.
You need people to see how independent you are, how well you're coping so they won't see the lost, hurt little girl.
Because that's not what you see.
You see someone who did something terrible who deserves to suffer, who doesn't deserve to live.
What did you do? Eventually, we'll find your parents, if only to deliver the body.
And they won't care.
You're an idiot.
You'd rather die than face your parents because of what? You broke their Fabergé egg? I killed their son.
I killed my brother.
I was supposed to watch him.
He was in the bath.
I could hear him laughing.
Every time they'd look at me, it's like I killed him again.
If you don't take your parents' bone marrow you'll be killing their other child.
If they don't hate you now, they will then.
I don't care.
Sure you do.
You want someone to tell you that it was just an accident, that it's not that bad.
Well, it is that bad, and you know it.
There's nothing you can do to change that but there is one thing you can do to not make it worse.
If you're here to celebrate the kid's bone marrow transplant working you missed cake.
I want to do clinical trials.
Already had this conversation.
I've proved I can work two cases at once.
I can do this, and I'm doing it.
Okay.
Okay? Just like that? Can I give my reasons later, or never? Three days ago you said no.
Three days ago, you asked me.
Now you told me.
Can't say no if it's not a question.
Nice thing you did for Foreman.
He speaks.
He deflects.
I almost cost a 4-year-old his life.
You knew Foreman would figure it out.
Did I? You just needed to prove it to him.
You're an ass, but a noble one.
I sound clever.
Thank you.
Your little game didn't work.
I'm not Foreman, and you're not me.
You want to talk about her? Nope.
All right.
You're gonna be okay, House.
Good to know.